The researchers identified patients with inflammatory bowel disease (IBD) such as ulcerative colitis and Crohn’s disease between the years 1964 and 2014 via the Swedish patient register. Using these data, they compared mortality rates in about 9,400 children who developed IBD with those of other children.
Their results show that children who developed IBD before the age of 18 have a three to five-fold higher mortality rate than people without IBD, both during childhood and into adulthood. This translates to a 2.2-year reduction in life expectancy in individuals monitored up to the age of 65.
Gastrointestinal
Gastric Cancer Risk Doubled With Long-term PPI Use
Source: Gastric Cancer Risk Doubled With Long-term PPI Use
The study was published online October 31 in Gut.
The researchers point out, however, that this was an observational study, which can’t prove cause and effect.
A strength of the study is its use of data from a large population-based database with complete information on subsequent diagnoses and drug prescriptions, which minimizes selection, information, and recall biases, the researchers say. Use of strict exclusion criteria as well as propensity score adjustment to control for potential confounders and restricting the sample to patients with successful H pylori eradication are other strengths.
In terms of study weaknesses, the researchers lacked information on some risk factors, such as diet, family history, and socioeconomic status. And despite the large sample of more than 63,000 H pylori–infected patients, the small number of gastric cancer cases did not allow for any “meaningful evaluation of the dosage effect and role of different PPIs,” the researchers say.
Mediterranean-style diet may eliminate need for reflux medications — ScienceDaily
Source: Mediterranean-style diet may eliminate need for reflux medications — ScienceDaily
When compared to patients who took the traditional reflux medication, proton pump inhibitors (PPI), those patients who consumed a 90-95% whole food, plant-based, Mediterranean-style diet paired with alkaline water had the same if not better reduction in reflux symptoms. 62.6 percent of patients treated with a plant-based diet and alkaline water saw a six point reduction in their Reflux Symptom Index (RSI — a measurement for the severity of reflux symptoms), compared to 54.1 percent reduction in patients taking PPI’s. Though this research only focused on those with laryngopharyngeal reflux, this same diet regimen has implications to help patients with gastro-esophageal acid reflux (also known as GERD).
The diet suggested by Dr. Zalvan consists of mostly fruits, vegetables, grains and nuts with near complete cessation of dairy and meats including beef, chicken, fish, eggs and pork. This is in addition to standard reflux diet precautions like avoiding coffee, tea, chocolate, soda, greasy and fried food, spicy foods, fatty foods and alcohol. Along with relieving reflux symptoms, Dr. Zalvan noted that many of his patients who were treated with a plant-based diet also experienced some weight loss and a reduction of symptoms and medication use from other medical conditions like high blood pressure and high cholesterol. Dr. Zalvan said that a plant-based diet approach with alkaline water and standard reflux precautions should either be attempted prior to the use of medication or with the short-term use of medication for more severe needs.
Small GISTs More Deadly Than Previously Thought
Enterobacteriaceae! 2 deaths at UCLA hospital; 179 potentially exposed – LA Times
Superbug linked to 2 deaths at UCLA hospital; 179 potentially exposed – LA Times.
“This bacteria is emerging in the U.S. and it’s associated with a high mortality rate,” Kallen said in an interview. “We don’t want this circulating anywhere in the community.”
Alcoholism after gastric bypass: Is it in your mind or gut? » Scienceline
In 2012, a large study published in the Journal of the American Medical Association reported that the percentage of patients abusing alcohol increased from 7.6 percent before surgery to 9.6 percent two years after surgery — that’s potentially an additional 2,000 alcoholics each year in the United States. Since then, a growing body of evidence has corroborated these findings. The longest-running study suggests the effect persists even a decade after surgery.
via Alcoholism after gastric bypass: Is it in your mind or gut? » Scienceline.
Reusable Grocery Bags Can Kill (Unless Washed)
Yum! The McRib is Back, Get Yours Today After You Find Out What’s In It
Linzess – Think IBS with Constipation
Linzess is felt to act as a guanylate cyclase-C agonist. An agonist increases the activity of a process, the opposite of an antagonist. Linzess seems to act locally on the surface of the inside of the intestinal lining cells and by activation of guanylate cyclase-C increases levels of intracellular cGMP (cyclic guanosine monophosphate) which results in increased levels of chloride and bicarbonate in the intestinal lumen and speeds up gastrointestinal transit.
Flex Sigmoidoscopy and Colorectal Cancer
Teaching Topic
Flexible Sigmoidoscopy and Colorectal Cancer
Original Article
R.E. Schoen and Others
Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Colorectal-cancer mortality and incidence are reduced with screening by means of fecal occult-blood testing. Endoscopic screening with flexible sigmoidoscopy or colonoscopy is more sensitive than fecal testing for the detection of adenomatous polyps, the precursor lesions of colorectal cancer.
Clinical Pearls
What were the results of this randomized trial comparing flexible sigmoidoscopy to usual care for screening of colorectal cancer?In this randomized study, flexible sigmoidoscopy, as compared with usual care, was associated with a 26% reduction in overall colorectal-cancer mortality and a 21% reduction in the incidence of colorectal cancer. Mortality related to distal colorectal cancer was reduced by 50%, and the incidence was reduced by 29%. A significant 14% reduction in the incidence of proximal colorectal cancer was observed, but there was no significant reduction in mortality related to proximal cancer.
According to the authors, what were the numbers needed to invite for screening via flexible sigmoidoscopy to prevent one diagnosis of colorectal cancer and one colorectal-cancer death?In this study, the number needed to invite for screening in order to prevent 1 case of colorectal cancer was 282 (95% CI, 210 to 427). The number needed to invite for screening to prevent 1 colorectal-cancer death was 871 (95% CI, 567 to 1874).
Morning Report Questions
Q. How did study participants differ from the usual-care group?
A. Participants in the intervention group were offered two screenings with flexible sigmoidoscopy, 3 to 5 years apart. Median follow up was 11.9 years. In the intervention group, 86.6% of participants (67,071) underwent at least one flexible sigmoidoscopic screening, and 50.9% (39,440) underwent two screenings. The estimated rate of endoscopy in the usual-care group during the screening phase was 25.8% (95% CI, 23.6 to 28.0) for flexible sigmoidoscopy, 34.4% (95% CI, 32.0 to 36.8) for colonoscopy, and 46.5% (95% CI, 43.9 to 49.1) for either flexible sigmoidoscopy or colonoscopy.
Q. How did screening-detected cancers differ from those diagnosed among participants who were never screened in terms of location and stage?
A. Screening-detected cancers accounted for 24.1% of colorectal cancers (244 of 1012) in the intervention group. Among participants with screening-detected cancers, 82.8% of the cancers were distal, whereas among participants who were never screened, 52.8% were distal, and among participants with cancers not detected by screening, 31.6% were distal (P<0.001). Participants with screening-detected cancers were more likely to have early-stage cancer (stage I or II) than participants who were never screened or those whose tumors were not detected by screening (75.4% vs. 50.9% and 50.7%, respectively; P<0.001).
Table 3. Colorectal-Cancer Incidence and Stage According to Means of Detection.
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